<table cellpadding="4" cellspacing="0" class="wdform_table1" style="border-top:0px solid black;"><tbody id="form_id_tempform_view1" class="wdform_tbody1" page_title="Untitled page" next_title="Next" next_type="button" next_class="wdform_page_button" next_checkable="false" previous_title="Previous" previous_type="button" previous_class="wdform_page_button" previous_checkable="false"><tr class="wdform_tr1"><td class="wdform_td1"><table class="wdform_table2"><tbody class="wdform_tbody2"><tr id="17" type="type_editor"><td id="17_element_sectionform_id_temp" align="left" valign="top" colspan="2" class="toolbar_padding"><h3>Interested in Respiratory Therapy at SJVC Visalia?<br>Please fill out and submit the form below.</h3></td><td id="X_17" valign="middle" align="right" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/delete_el.png" height="17" title="Remove the field" style="cursor: pointer; margin: 2px;" onclick="remove_row(&quot;17&quot;)"></td><td id="left_17" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/left.png" title="Move the field to the left" style="margin: 2px; cursor: pointer;" onclick="left_row(&quot;17&quot;)"></td><td id="up_17" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/up.png" title="Move the field up" style="cursor: pointer;" onclick="up_row(&quot;17&quot;)"></td><td id="down_17" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/down.png" title="Move the field down" style="margin: 2px; cursor: pointer;" onclick="down_row(&quot;17&quot;)"></td><td id="right_17" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/right.png" title="Move the field to the right" style="cursor: pointer;" onclick="right_row(&quot;17&quot;)"></td><td id="edit_17" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/edit.png" title="Edit the field" style="margin: 2px; cursor: pointer;" onclick="edit(&quot;17&quot;)"><span id="17_element_labelform_id_temp" style="display: none;">custom_17</span></td><td id="dublicate_17" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/dublicate.png" title="Dublicate the field" style="margin: 2px; cursor: pointer;" onclick="dublicate(&quot;17&quot;)"></td><td id="dublicate_17" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/page_down.png" title="Move the field to the lower  page" style="margin: 2px; cursor: pointer;" onclick="page_down(&quot;17&quot;)"></td><td id="page_up_17" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/page_up.png" title="Move the field to the upper page" style="margin: 2px; cursor: pointer;" onclick="page_up(&quot;17&quot;)"></td></tr><tr id="1" type="type_text"><td valign="middle" align="left" id="1_label_sectionform_id_temp" class=""><span id="1_element_labelform_id_temp" class="label">Full Name (First and Last)</span><span id="1_required_elementform_id_temp" class="required"></span></td><td valign="middle" align="left" id="1_element_sectionform_id_temp" class=" toolbar_padding"><input type="hidden" value="type_text" name="1_typeform_id_temp" id="1_typeform_id_temp"><input type="hidden" value="no" name="1_requiredform_id_temp" id="1_requiredform_id_temp"><input type="hidden" value="no" name="1_uniqueform_id_temp" id="1_uniqueform_id_temp"><input type="text" style="width: 200px;" class="input_deactive" id="1_elementform_id_temp" name="1_elementform_id_temp" value="" title="" onfocus="delete_value(&quot;1_elementform_id_temp&quot;)" onblur="return_value(&quot;1_elementform_id_temp&quot;)" onchange="change_value(&quot;1_elementform_id_temp&quot;)"></td><td id="X_1" valign="middle" align="right" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/delete_el.png" height="17" title="Remove the field" style="cursor: pointer; margin: 2px;" onclick="remove_row(&quot;1&quot;)"></td><td id="left_1" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/left.png" title="Move the field to the left" style="margin: 2px; cursor: pointer;" onclick="left_row(&quot;1&quot;)"></td><td id="up_1" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/up.png" title="Move the field up" style="cursor: pointer;" onclick="up_row(&quot;1&quot;)"></td><td id="down_1" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/down.png" title="Move the field down" style="margin: 2px; cursor: pointer;" onclick="down_row(&quot;1&quot;)"></td><td id="right_1" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/right.png" title="Move the field to the right" style="cursor: pointer;" onclick="right_row(&quot;1&quot;)"></td><td id="edit_1" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/edit.png" title="Edit the field" style="margin: 2px; cursor: pointer;" onclick="edit(&quot;1&quot;)"></td><td id="dublicate_1" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/dublicate.png" title="Dublicate the field" style="margin: 2px; cursor: pointer;" onclick="dublicate(&quot;1&quot;)"></td><td id="page_up_1" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/page_up.png" title="Move the field to the upper page" style="margin: 2px; cursor: pointer;" onclick="page_up(&quot;1&quot;)"></td><td id="dublicate_1" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/page_down.png" title="Move the field to the lower  page" style="margin: 2px; cursor: pointer;" onclick="page_down(&quot;1&quot;)"></td></tr><tr id="5" type="type_submitter_mail"><td valign="middle" align="left" id="5_label_sectionform_id_temp" class=""><span id="5_element_labelform_id_temp" class="label">E-mail:</span><span id="5_required_elementform_id_temp" class="required"></span></td><td valign="middle" align="left" id="5_element_sectionform_id_temp" class=" toolbar_padding"><input type="hidden" value="type_submitter_mail" name="5_typeform_id_temp" id="5_typeform_id_temp"><input type="hidden" value="no" name="5_requiredform_id_temp" id="5_requiredform_id_temp"><input type="hidden" value="no" name="5_sendform_id_temp" id="5_sendform_id_temp"><input type="hidden" value="" name="5_uniqueform_id_temp" id="5_uniqueform_id_temp"><input type="text" style="width: 200px;" class="input_deactive" id="5_elementform_id_temp" name="5_elementform_id_temp" value="" title="" onfocus="delete_value('5_elementform_id_temp')" onblur="return_value('5_elementform_id_temp')" onchange="change_value('5_elementform_id_temp')"></td><td id="X_5" valign="middle" align="right" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/delete_el.png" height="17" title="Remove the field" style="cursor: pointer; margin: 2px;" onclick="remove_row(&quot;5&quot;)"></td><td id="left_5" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/left.png" title="Move the field to the left" style="margin: 2px; cursor: pointer;" onclick="left_row(&quot;5&quot;)"></td><td id="up_5" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/up.png" title="Move the field up" style="cursor: pointer;" onclick="up_row(&quot;5&quot;)"></td><td id="down_5" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/down.png" title="Move the field down" style="margin: 2px; cursor: pointer;" onclick="down_row(&quot;5&quot;)"></td><td id="right_5" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/right.png" title="Move the field to the right" style="cursor: pointer;" onclick="right_row(&quot;5&quot;)"></td><td id="edit_5" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/edit.png" title="Edit the field" style="margin: 2px; cursor: pointer;" onclick="edit(&quot;5&quot;)"></td><td id="dublicate_5" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/dublicate.png" title="Dublicate the field" style="margin: 2px; cursor: pointer;" onclick="dublicate(&quot;5&quot;)"></td><td id="page_up_5" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/page_up.png" title="Move the field to the upper page" style="margin: 2px; cursor: pointer;" onclick="page_up(&quot;5&quot;)"></td><td id="dublicate_5" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/page_down.png" title="Move the field to the lower  page" style="margin: 2px; cursor: pointer;" onclick="page_down(&quot;5&quot;)"></td></tr><tr id="3" type="type_number"><td valign="middle" align="left" id="3_label_sectionform_id_temp" class=""><span id="3_element_labelform_id_temp" class="label">Phone:</span><span id="3_required_elementform_id_temp" class="required"></span></td><td valign="middle" align="left" id="3_element_sectionform_id_temp" class=" toolbar_padding"><input type="hidden" value="type_number" name="3_typeform_id_temp" id="3_typeform_id_temp"><input type="hidden" value="no" name="3_requiredform_id_temp" id="3_requiredform_id_temp"><input type="hidden" value="no" name="3_uniqueform_id_temp" id="3_uniqueform_id_temp"><input type="text" style="width: 200px;" class="input_deactive" id="3_elementform_id_temp" name="3_elementform_id_temp" value="" title="" onkeypress="return check_isnum(event)" onfocus="delete_value(&quot;3_elementform_id_temp&quot;)" onblur="return_value(&quot;3_elementform_id_temp&quot;)" onchange="change_value(&quot;3_elementform_id_temp&quot;)"></td><td id="X_3" valign="middle" align="right" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/delete_el.png" height="17" title="Remove the field" style="cursor: pointer; margin: 2px;" onclick="remove_row(&quot;3&quot;)"></td><td id="left_3" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/left.png" title="Move the field to the left" style="margin: 2px; cursor: pointer;" onclick="left_row(&quot;3&quot;)"></td><td id="up_3" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/up.png" title="Move the field up" style="cursor: pointer;" onclick="up_row(&quot;3&quot;)"></td><td id="down_3" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/down.png" title="Move the field down" style="margin: 2px; cursor: pointer;" onclick="down_row(&quot;3&quot;)"></td><td id="right_3" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/right.png" title="Move the field to the right" style="cursor: pointer;" onclick="right_row(&quot;3&quot;)"></td><td id="edit_3" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/edit.png" title="Edit the field" style="margin: 2px; cursor: pointer;" onclick="edit(&quot;3&quot;)"></td><td id="dublicate_3" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/dublicate.png" title="Dublicate the field" style="margin: 2px; cursor: pointer;" onclick="dublicate(&quot;3&quot;)"></td><td id="page_up_3" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/page_up.png" title="Move the field to the upper page" style="margin: 2px; cursor: pointer;" onclick="page_up(&quot;3&quot;)"></td><td id="dublicate_3" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/page_down.png" title="Move the field to the lower  page" style="margin: 2px; cursor: pointer;" onclick="page_down(&quot;3&quot;)"></td></tr><tr id="4" type="type_checkbox"><td valign="top" align="left" id="4_label_sectionform_id_temp" class=""><span id="4_element_labelform_id_temp" class="label">Receive text messages from SJVC:</span><span id="4_required_elementform_id_temp" class="required"></span></td><td valign="top" align="left" id="4_element_sectionform_id_temp" class=" toolbar_padding"><input type="hidden" value="type_checkbox" name="4_typeform_id_temp" id="4_typeform_id_temp"><input type="hidden" value="no" name="4_requiredform_id_temp" id="4_requiredform_id_temp"><input type="hidden" value="no" name="4_randomizeform_id_temp" id="4_randomizeform_id_temp"><input type="hidden" value="0" name="4_allow_otherform_id_temp" id="4_allow_otherform_id_temp"><input type="hidden" value="0" name="4_allow_other_numform_id_temp" id="4_allow_other_numform_id_temp"><table><tbody id="4_table_little"><tr id="4_element_tr0"><td valign="top" id="4_td_little0" idi="0"><input type="checkbox" id="4_elementform_id_temp0" name="4_elementform_id_temp0" value="Yes" onclick="set_checked('4','0','form_id_temp')"><label id="4_label_element0" class="ch_rad_label" for="4_elementform_id_temp0">Yes</label></td></tr></tbody></table></td><td id="X_4" valign="middle" align="right" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/delete_el.png" height="17" title="Remove the field" style="cursor: pointer; margin: 2px;" onclick="remove_row(&quot;4&quot;)"></td><td id="left_4" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/left.png" title="Move the field to the left" style="margin: 2px; cursor: pointer;" onclick="left_row(&quot;4&quot;)"></td><td id="up_4" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/up.png" title="Move the field up" style="cursor: pointer;" onclick="up_row(&quot;4&quot;)"></td><td id="down_4" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/down.png" title="Move the field down" style="margin: 2px; cursor: pointer;" onclick="down_row(&quot;4&quot;)"></td><td id="right_4" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/right.png" title="Move the field to the right" style="cursor: pointer;" onclick="right_row(&quot;4&quot;)"></td><td id="edit_4" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/edit.png" title="Edit the field" style="margin: 2px; cursor: pointer;" onclick="edit(&quot;4&quot;)"></td><td id="dublicate_4" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/dublicate.png" title="Dublicate the field" style="margin: 2px; cursor: pointer;" onclick="dublicate(&quot;4&quot;)"></td><td id="page_up_4" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/page_up.png" title="Move the field to the upper page" style="margin: 2px; cursor: pointer;" onclick="page_up(&quot;4&quot;)"></td><td id="dublicate_4" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/page_down.png" title="Move the field to the lower  page" style="margin: 2px; cursor: pointer;" onclick="page_down(&quot;4&quot;)"></td></tr><tr id="8" type="type_submit_reset"><td colspan="2" class="toolbar_padding" id="8_label_and_element_sectionform_id_temp"><table id="8_elemet_tableform_id_temp"><tbody><tr><td valign="middle" align="left" id="8_label_sectionform_id_temp" style="display: none;" class=""><span id="8_element_labelform_id_temp" style="display: none;">type_submit_reset_8</span></td><td valign="middle" align="left" id="8_element_sectionform_id_temp" class=""><input type="hidden" value="type_submit_reset" name="8_typeform_id_temp" id="8_typeform_id_temp"><button type="button" class="button_submit" id="8_element_submitform_id_temp" value="Submit" onclick="check_required('submit', 'form_id_temp');">Submit</button><button type="button" class="button_reset" style="display: none;" id="8_element_resetform_id_temp" value="Reset" onclick="check_required('reset');">Reset</button></td></tr></tbody></table></td><td id="X_8" valign="middle" align="right" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/delete_el.png" height="17" title="Remove the field" style="cursor: pointer; margin: 2px;" onclick="remove_row(&quot;8&quot;)"></td><td id="left_8" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/left.png" title="Move the field to the left" style="margin: 2px; cursor: pointer;" onclick="left_row(&quot;8&quot;)"></td><td id="up_8" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/up.png" title="Move the field up" style="cursor: pointer;" onclick="up_row(&quot;8&quot;)"></td><td id="down_8" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/down.png" title="Move the field down" style="margin: 2px; cursor: pointer;" onclick="down_row(&quot;8&quot;)"></td><td id="right_8" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/right.png" title="Move the field to the right" style="cursor: pointer;" onclick="right_row(&quot;8&quot;)"></td><td id="edit_8" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/edit.png" title="Edit the field" style="margin: 2px; cursor: pointer;" onclick="edit(&quot;8&quot;)"></td><td id="dublicate_8" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/dublicate.png" title="Dublicate the field" style="margin: 2px; cursor: pointer;" onclick="dublicate(&quot;8&quot;)"></td><td id="page_up_8" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/page_up.png" title="Move the field to the upper page" style="margin: 2px; cursor: pointer;" onclick="page_up(&quot;8&quot;)"></td><td id="dublicate_8" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/page_down.png" title="Move the field to the lower  page" style="margin: 2px; cursor: pointer;" onclick="page_down(&quot;8&quot;)"></td></tr><tr id="6" type="type_editor"><td id="6_element_sectionform_id_temp" align="left" valign="top" colspan="2" class="toolbar_padding"><p>By submitting this form, you acknowledge that SJVC will contact you by phone, email, mail or text message (if you opted in). You are giving SJVC express consent to contact you at the phone number provided for responding to this inquiry, and this will include removal of the number from SJVC's Do Not Call List. View our <a data-mce-href="http://www.sjvc.edu/privacy-policy" href="http://www.sjvc.edu/privacy-policy" title="Privacy Policy" target="_blank">privacy policy</a> for details on how your information may be used.</p></td><td id="X_6" valign="middle" align="right" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/delete_el.png" height="17" title="Remove the field" style="cursor: pointer; margin: 2px;" onclick="remove_row(&quot;6&quot;)"></td><td id="left_6" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/left.png" title="Move the field to the left" style="margin: 2px; cursor: pointer;" onclick="left_row(&quot;6&quot;)"></td><td id="up_6" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/up.png" title="Move the field up" style="cursor: pointer;" onclick="up_row(&quot;6&quot;)"></td><td id="down_6" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/down.png" title="Move the field down" style="margin: 2px; cursor: pointer;" onclick="down_row(&quot;6&quot;)"></td><td id="right_6" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/right.png" title="Move the field to the right" style="cursor: pointer;" onclick="right_row(&quot;6&quot;)"></td><td id="edit_6" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/edit.png" title="Edit the field" style="margin: 2px; cursor: pointer;" onclick="edit(&quot;6&quot;)"><span id="6_element_labelform_id_temp" style="display: none;">custom_6</span></td><td id="dublicate_6" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/dublicate.png" title="Dublicate the field" style="margin: 2px; cursor: pointer;" onclick="dublicate(&quot;6&quot;)"></td><td id="dublicate_6" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/page_down.png" title="Move the field to the lower  page" style="margin: 2px; cursor: pointer;" onclick="page_down(&quot;6&quot;)"></td><td id="page_up_6" valign="middle" class="element_toolbar"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/page_up.png" title="Move the field to the upper page" style="margin: 2px; cursor: pointer;" onclick="page_up(&quot;6&quot;)"></td></tr></tbody></table></td></tr><tr class="wdform_footer"><td colspan="100" valign="top"><table width="100%" style="padding-right:170px"><tbody><tr id="form_id_temppage_nav1"></tr></tbody></table></td></tr></tbody><tbody id="form_id_tempform_view_img1" style="float:right !important ;"><tr><td width="0%"></td><td align="right"><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/minus.png" title="Show or hide the page" class="page_toolbar" onclick="show_or_hide('1')" id="show_page_img_1"></td><td><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/page_delete.png" title="Delete the page" class="page_toolbar" onclick="remove_page('1')"></td><td><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/page_delete_all.png" title="Delete the page with fields" class="page_toolbar" onclick="remove_page_all('1')"></td><td><img src="http://www.sjvc.edu/wp-content/plugins/form-maker/images/page_edit.png" title="Edit the page" class="page_toolbar" onclick="edit_page_break('1')"></td></tr></tbody></table>